Clinical diagnosis of head & neck conditions Flashcards
Common presenting head &neck symptoms (7)
Persistent sore throat Dysphonia - hoarseness Dysphagia- difficulty swallowing Odynophagia- painful swallowing Otalgia- earache Mouth/throat ulcer Neck lump
Physical examination of head &neck includes what structures (7)
Neck Nose Ears Oral cavity Pharynx Larynx Salivary glands
Investigation of throat
Laryngoscopy = endoscopy of larynx
Investigations for head & neck pathologies (8)
FNAC
CT/MRI/PET
USS
Plain XR
Contrast swallow
Endoscopy
1st line investigation for neck lump
FNAC
Questions to ask in PC about a neck lump (5)
How long have they had it? Has it changed size/got better worse? Does it fluctuate (does it come and go)? Any pain with the lump? Any symptoms associated with lump/any other lumps?
Physical examination of the lump should consider what properties of the lump (6)
Size Shape Soreness Skin Mobility - fixed or mobile Soft/firm
Neck lump differentials (5)
Branchial cyst Lipoma Thyroglossal cyst Reactive lymph node Tumour
Properties of a neck tumour (4)
Round, firm, fixed (immobile), non-tender
What does globus pharyngeus refer to + what is it associated with
A feeling of a lump in the throat
Acid reflux
3 salivary gland conditions
Pleomorphic adenoma
Parotitis
Salivary duct calculus (stones)
What is a pleomorphic adenoma
Tumour of the parotid gland
What are salivary duct calculi + what symptoms do they cause
Stones blocking salivary ducts - usually in submandibular duct
Pain and swelling of affected gland
Questions to ask a patient with hoarseness (9)
How long have they had it? Is it persistent or intermittent? Is there any pain associated with the hoarseness? Is there any cough associated? Are there problems with swallowing? Do they sing? Do they have asthma? Do they have acid reflux? Do they smoke?
Causes of hoarseness (7)
Nodules in vocal cord Cysts in vocal cord Vocal abuse Laryngitis Infection Smoking Laryngeal cancer
Pathophysiology of hoarseness
Damage of recurrent laryngeal nerve (branch of CN X)
Questions to ask a patient with dysphagia (4)
What do you find difficulty doing?
Is it persistent/intermittent?
Is there any pain?
Where is the dysphagia located? - usually upper/middle neck
Causes of dysphagia (4)
Foreign body in oesophagus
Tumour
Stricture
Pharyngeal pouch
Dysphagia investigations
UGIE
Barium swallow
Head and neck cancers are predominately what type of tumour
Squamous carcinoma
Head & neck cancer treatments (3)
Surgery - neck dissection + flap reconstruction
Palliative radiotherapy/chemotherapy
What is stridor
High pitched noisy breathing caused by airway obstruction
2 types of stridor + what area of the airway is usually obstructed to cause that type of stridor
Inspiratory stridor = laryngeal obstruction; usually above glottis
Expiratory stridor (wheeze) = tracheobronchial obstruction; usually lower trachea
Difference between wheeze and stridor
Wheeze is only during expiration whereas stridor can be both
Management of stridor
ABC: Secure airway - intubate or tracheostomy Oxygen Steroids (IV dexamethasone) Nebulised adrenaline
Tonsillitis pathogenic causes
Usually virus, less so bacteria
Tonsillitis symptoms (3) + signs (4)
Sore throat
Dysphagia
Stiff neck
Red swollen tonsils
White patches on tonsils
Fever
Enlarged cervical lymph nodes
Complication of tonsillitis (1)
Quinsy (peritonsillar abscess) - collection of pus behind tonsil
Tonsillitis investigations (2)
Throat swab + culture
Streptococcal antigen test - to see if it’s bacterial tonsillitis
Tonsillitis treatment (viral and bacterial) (3)
Viral - rest, fluids, treat fever
Bacterial - antibiotics
Tonsillectomy if tonsillitis recurs of if bacterial tonsillitis doesn’t respond to antibiotics
Questions to ask in SH about a neck lump (4)
Smoking
Alcohol
Foreign travel
Recreational drugs
Questions to ask in PMH about a neck lump (5)
Recent URTI? Previous or existing head & neck disease? Immunosuppression? Existing DM? Existing or previous TB?
Associated symptoms to ask about in a general systematic enquiry of a neck lump (5)
Weight loss Anorexia Fever Night sweats Bone pain
